CARE HOMES FOR OLDER PEOPLE
NIghtingale Nursing Home 43 Beach Road Littlehampton West Sussex BN17 5JG Lead Inspector
Helen Tomlinson Unannounced 28 July 08:00, V229846
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Nightingale Nursing Home Address 43 beach Road, Littlehampton, West Sussex, BN17 5JG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01903 717376 01903 732933 Cadogan Care Ltd Mrs Tracey Elizabeth Searle CRH(N) - Care home with nursing 35 Category(ies) of OP-Old age 35 places registration, with number of places NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9 November 2004 Brief Description of the Service: Nightingale Nursing Home is registered to accommodate up to thirty five residents in the category of Older People. The property is a detached three storey Edwardian house located in the town of Littlehampton. The house overlooks a park and is a few minutes walk from the shops, public transport, local amenities and the sea front. The accommodation is provided on two floors with a lift providing access between the ground and first floor. There are 31 single rooms with three rooms offering en-suite facilities and two rooms offering shared facilities. One single room is accesible via a short flight of stairs. A lounge with dining space is available on each floor. There is outdoor space available with seating for the residents. NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived at 8am and left at 3pm. The registered manager was present throughout the inspection. Over the course of the inspection eleven residents, one visitor and seven members of staff were spoken with. Staff were observed giving support and assistance. Three residents files were examined in detail and other records were seen as was necessary. A tour of the premises took place. Staff files were examined What the service does well:
The residents benefit from thorough information being recorded about their needs and how these are to be met by the staff in the home. This leads to a consistent approach to the care of the residents. Residents commented that the staff cared for and supported them in a manner which they liked. The individual risks to residents were minimised by a thorough assessment of various risks being carried out and action taken to reduce these risks. Residents were cared for in a way which respected their privacy and dignity. Residents said the staff were polite and friendly when offering care and support. Residents benefit from a range of activities which they said suited their needs and wishes. Residents praised the quality, quantity and choice of meals served. They were able to eat them in the dining room or their bedrooms. Residents, relatives and friends benefit from an open atmosphere in the home where they can raise any concerns or issues feeling confident that they will be fully addressed. The written procedures regarding the protection of vulnerable adults would ensure the correct procedures were followed to make the residents safe. The residents live in a home which was clean and tidy. NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Residents were not admitted to the home unless an assessment of their needs had been carried out. EVIDENCE: Three resident’s files were examined. These all contained an assessment of their needs which had been completed, by an appropriate member of staff at the home, prior to their admission. This assessment gave a good picture of the resident and their strengths and needs. Assessments by other professionals were present as appropriate. NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 All residents had a plan of care which had been drawn up from assessments of their needs and abilities. The health care needs of the residents were met. The home’s medication procedures were followed and staff were keen to improve practice where possible. The residents were treated with dignity and their privacy was respected and protected. EVIDENCE: The three resident’s files which were examined contained comprehensive care plans which included all areas of their life. The abilities and choices of the resident as well as their needs were documented. These care plans were devised from various assessments which covered all areas of daily life. They were reviewed in line with the assessments and when any change to the resident’s condition occurred. These care plans contained a lot of information and it was discussed with the registered manager that when a resident had been in the home for a number of years it was confusing to have all the information still on file. It was recommended that only current information be stored on the files and other information be securely stored elsewhere in the home.
NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 10 The various assessments which were carried out for the residents covered all possible health care needs. These included the risk of developing a pressure sore, baseline observations of blood pressure, pulse and weight, an assessment of need for moving and handling, falls risk assessment and bed rail risk assessment. These assessments were used for the basis of the care plan which ensured the needs of the residents were met. There were no nutritional assessments on file and these should be done for any resident who has difficulties with eating and drinking. A care plan for the risk of choking was present for one resident with this risk identified. Wound care charts which contained detail about the changes to the wound and dressings to be applied were present for all residents with a wound. Any specialist equipment needed as a result of these assessments was provided and seen to be used. There was evidence of frequent communication with other health professionals as was necessary. The qualified nurses in the home showed a commitment to keep themselves professionally up dated and to deliver a good quality of nursing care. The care plans and health assessments were regularly reviewed and any changes fully documented. Medication policy and procedures include giving residents the choice of selfadministration. Storage was clean and tidy with temperatures monitored. One out of date medicine was on the medicine trolley. The storing of all eye drops in the medicines refrigerator was discussed. Maintenance records for medical equipment were not available. Medicine administration was seen to be carried out correctly. Changes in medication were documented. Residents said the staff respected them when they were assisting them with personal care. They said that bedroom and bathroom doors were shut, staff knocked before entering and spoke to them in a polite manner. All residents said the staff thought about their dignity and preserved this in the way they helped them. NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 The activities in the home suited the needs and wishes of the residents living there. EVIDENCE: The residents discussed the various activities which were available in the home. These included Velcro darts, art classes and group entertainment. Residents had books, radios and televisions in their rooms and several discussed that they preferred this to the more organised activities which took place. They liked the fact they had a choice of whether or not to join the activities which were offered. The residents past interests and hobbies were documented on arrival to the home. A picture of the people who were important in their lives was given and staff were able to discuss the social needs of the residents in their care. NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Residents and relatives were confident that any concerns they raised would be taken seriously and addressed appropriately. The written procedures in the home would protect the residents from abuse. Staff were not adequately trained in the protection of vulnerable adults to recognise all potential risks. EVIDENCE: Residents spoken with stated they would approach any member of staff, or the manager, should they have any concerns or issues. Had they had call to do this they said the matter had been resolved quickly and to their satisfaction. A record of three complaints/incidents was seen. This included the action taken to resolve the issues and reduce the likelihood of it happening again. They had all been resolved to the satisfaction of all parties involved. No allegations of abuse had been made at the home. The written procedures in the home, should an allegation of abuse be made, would protect the residents from the risk of further abuse. The care staff had not received training regarding the protection of vulnerable adults. This should be done in order for them to recognise the potential risks to residents and their responsibilities with regard to protection. NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 The home was generally well maintained. Some aspects of fire safety could present a risk to residents. EVIDENCE: On arrival the home was clean, tidy and free from offensive odour. A maintenance man carries out any day to day repairs which are necessary for the general running of the home. On the day of the inspection the lift was out of order and had been for one week. A new part was needed before the lift could be repaired and this was on order. The proprietor informed the inspector that the lift had been repaired shortly after the inspection. This breakdown had been well managed with staff working on the first floor at all times and a lounge/dining room being available for the residents on this floor. The residents spoken with described it as a “nuisance” since they could not get downstairs to go outside, but understood that it was outside the control of the home. This breakdown had not been reported to the Commission as it should have been, since the welfare of the residents was affected. NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 14 The fire doors on the corridors were held open by magnetic closures which met with the guidance of the fire service. All resident’s bedroom doors were closed during the inspection, however residents reported this was not usually the case and some had them wedged open during the day. No fire doors should be held open by any device other than that which meets with the approval of the fire service. The fire door between the kitchen and the dining room did not shut fully and so was ineffective as a fire door. This was pointed out to the manager at the time of the inspection as needing urgent repair. Staff were aware of the fire procedure and had received fire training. It was not possible to understand, from the training records, if all staff had received up to date training. All staff must of received up to date fire safety training and this must be fully documented. NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The number and skill mix of staff on duty was adequate to meet the needs of the residents. It was not possible to assess if the residents were protected by the recruitment procedures in the home since the records for new staff were not present. EVIDENCE: The duty rota for week commencing 24th July 2005 was seen. This showed that one qualified nurse and 4 care staff were on duty in the mornings with one and three in the afternoons. At night one qualified nurse and three care staff were on duty. Staff reported that this number worked well, though currently, with the lift out of order, there was extra work to assist those residents on the first floor, especially at mealtimes. The staff numbers should be kept under review and be adequate to meet the resident’s needs at all times. Two recruitment files for the newest care staff were seen. These contained only the application form. The inspector spoke to the proprietor who assured the inspector that all the necessary checks, to make sure they were fit to work with vulnerable adults, had been carried out. The manager and the proprietor were informed that the information gathered on recruitment must be kept securely in the care home, along with evidence that all necessary checks have been carried out. NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The majority of practices in the home protected the residents, however some aspects of health and safety need reviewing. EVIDENCE: Environmental risk assessments had been carried out on each individual bedroom. This was very thorough and assessed all potential hazards in the room, for the individual resident who was accommodated there. These had been regularly reviewed. Actions to reduce identified risks were present. Staff showed some awareness of health and safety issues. Statutory training in the aspects of the health and safety of the residents should be up to date for all staff. The records indicated that fire safety and moving and handling training were not up to date for all staff. There was only one member of staff who had completed the first aid training. The cook on duty on the day of the inspection had not received basic food hygiene training. All staff should be adequately trained for the work they are to perform. NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 17 The carpet on the ground floor corridor was worn and presented a trip hazard to staff and residents. This should be repaired or replaced. The accident book was seen. All accidents had been appropriately recorded. NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x x x 2 NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 18 19 Regulation 13(6) 23(4)(c )(i) Requirement Staff must receive training in the protection of vulnerable adults. All fire doors must be closed unless held open by a device which is approved of by the fire service. All fire doors must be in good working order. All staff must be recruited so as to be sure they are fit to work with vulnerable adults. The recruitment records must be kept in the care home. All staff must receive training for the work they are to perform. Records must be kept of all training undertaken. All parts of the care home must be free from hazards to the safety of the residents. The carpet on the ground floor corridor must be made safe. Timescale for action 31/10/05 31/8/05 3. 29 19 and Schedule 2 18(1)(i) 31/8/05 4. 38 31/10/05 5. 38 13(4)(a) 31/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations
H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 20 NIghtingale Nursing Home 1. 2. 8 9 The care plans should contain current information only. Medical equipment should be regularly maintained and medicines stored according to the manufacturers instructions. NIghtingale Nursing Home H60-H11 S24181 Nightingale Nursing Home V229846 280705 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 2nd Floor, Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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